Provider Demographics
NPI:1497059943
Name:MEYER, JENIFER CLARK (NP)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:CLARK
Last Name:MEYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 CLINTON AVE S
Mailing Address - Street 2:BLDG G-2
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2668
Mailing Address - Country:US
Mailing Address - Phone:585-341-7685
Mailing Address - Fax:585-341-4220
Practice Address - Street 1:2400 CLINTON AVE S
Practice Address - Street 2:BUILDING G, 2ND FLOOR
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2668
Practice Address - Country:US
Practice Address - Phone:585-341-7685
Practice Address - Fax:585-341-4220
Is Sole Proprietor?:No
Enumeration Date:2010-12-26
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306895363LA2200X, 363LA2200X, 363L00000X, 363LP2300X
NY683274163W00000X, 163W00000X
CT004486363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04145942Medicaid
NYJ400228943Medicare PIN